MAID, mental illness and your Health Care Directive: What Ottawa’s MAID Safeguards Act announcement means for Manitobans

On October 7, 2026, the Federal government announced its next steps on medical assistance in dying (MAID). For many Manitobans, the news raises a practical question: hat can I put in my Health Care Directive, and will anyone be able to act on it?

The MAID Safeguards Act, Bill C-41, was officially introduced on October 27, 2026. The Bill would amend the Criminal Code of Canada to “clarify that a person cannot receive medical assistance in dying on the basis of a mental illness.” The question of “advance requests” for MAID treatment lends itself to a discussion about the power Health Care Directives in Manitoba.

Health Care Directives in Manitoba: The basics

What it is: A written document under Manitoba’s Health Care Directives Act that records your wishes about the type and amount of health care you want if you can no longer speak for yourself.

What it does: Your wishes are generally binding on family and health care providers subject to the requirement that they be consistent with accepted health care practice and the certain limits set out in the Act. The government form is optional – any signed, dated document with the same information works

Why have one: It spares your loved ones from guessing during a crisis.

Your proxy: A person you name to make health care decisions for you, guided by your directive and what you have told them. You can name more than one, acting together or one after another.

Who can make one: Under the Act, people 16 and older are presumed to have the capacity to make a directive. By contrast, MAID is available only to adults 18 and older.

What the Act is about

During the October 7 announcement, Justice Minister Sean Fraser said the government will table legislation this fall to indefinitely exclude people whose only medical condition is a mental illness from MAID. That eligibility had been scheduled to begin on March 17, 2027. It will not proceed if the new law passes.

The government cited a lack of consensus on whether mental illness can be “irremediable” and concerns about access to mental health supports. This follows a June 2026 recommendation from the Special Joint Committee on Medical Assistance in Dying. The same legislation would decriminalize advance requests for MAID for people diagnosed with a serious illness who may later lose the capacity to consent. Each province will decide whether to offer advance requests, because provinces run health care delivery.

Quebec already permits advance requests under its own law, although the Federal Criminal Code does not yet authorize them. Alberta has said it will not allow them. As of today, Manitoba has not announced its position.

MAID and your Health Care Directive: The tricky part

A Health Care Directive and a MAID “advance request” are two different things.

Today, a Manitoba directive cannot be used to request or consent to MAID. MAID is governed by the Federal Criminal Code (sections 241.1 to 241.4), not Provincial directive laws. Shared Health Manitoba states that consent through a substitute decision maker or a personal advance directive is “not applicable.” However, you may still write down your views on MAID. A statement of your values (for example, that you would want to explore MAID or that you never want it) can guide conversations with your family, proxy and care team. It is not a legal request and cannot be acted on as one.

Directives can still refuse treatment. You can decline life-sustaining treatment such as tube feeding or resuscitation (and even direct that it be withdrawn if it has been initiated). That is not MAID and is fully permitted.

Can a health care proxy start or continue a MAID request?

No. The Canadian government states plainly that a proxy or substitute decision maker cannot consent to MAID. Only the person themselves, while capable, can make the request. An individual must be assessed by two independent medical practitioners and provide a signed written request providing their consent. This consent can be withdrawn at any time.

A proxy cannot start a request and cannot continue one if the person loses capacity, except where the patient themselves signed a waiver of final consent before losing capacity (see Track 1 below). That exception depends on the patient’s own prior written arrangement, not the proxy.

No advance planning route for mental illness alone

Manitoba has no process for advance planning of MAID where mental illness is the sole condition. Federal law excludes these cases, and this recent announcement would extend that exclusion indefinitely. Manitoba’s Health Minister has publicly supported the delay. Having a mental illness does not on its own disqualify a person: People with a mental illness plus a qualifying physical condition may still be assessed under the existing rules.

How this compares with MAID for a physical illness

Eligibility (Criminal Code s. 241.2): Adults 18 years of age or older, who are eligible for public health care and capable of making decisions about their health, with a serious and incurable illness, disease or disability, in an advanced state of irreversible decline in capability, experiencing enduring and intolerable suffering, making a voluntary request and giving informed consent.

Death reasonably foreseeable (“Track 1”): No minimum waiting period. A person who has already been assessed and approved for MAID, has set a date and who is at risk of losing capacity may sign a written waiver of final consent with their practitioner, so MAID can proceed on the agreed-upon date even if they lose capacity. This is the only form of “advance consent” in force today, and it is not the same as an advance request.

Death not reasonably foreseeable (“Track 2”): A minimum 90-day assessment period, an assessor with expertise in the condition and final consent immediately before MAID. No waiver is available.

Mental illness as the sole condition: Not eligible at all, on either track.

Key takeaways

• Make or update your Health Care Directive and choose a proxy who understands and will respect your values.
• Talk to your doctor about your diagnosis and options, including palliative care.
• Record your values on MAID if you wish, understanding it is guidance only and not a legal request.
• Tell people where your directive is – providers are not required to look for it.
• Review your plan when your health changes or when the law changes. We will be watching for the Federal bill and Manitoba’s response.
• Get advice tailored to you from a lawyer and your health care team.

Our Trusts, Estates and Legacy Planning group offers comprehensive legal services for individuals, families and business clients across Western Canada. We guide clients through every stage of estate planning, wills, administration and litigation with professionalism and compassion.

Whether you are planning your legacy, preparing for potential incapacity, establishing a trust to manage intergenerational wealth, administering an estate or facing complex estate disputes, our experienced team is here to offer clear, strategic advice tailored to your unique needs and priorities.

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